For face, flexures and genitals

The first-line treatment for the face, flexures and genitals is a mild or moderate potency corticosteroid for two weeks. If this is ineffective then a topical calcineurin inhibitor (e.g. tacrolimus, pimecrolimus) is recommended.

For scalp psoriasis 

Scalp psoriasis can be itchy and feel tight or sore. Some people shed large numbers of silvery-white skin flakes but others can have a thick, unsightly layer of scale. 

Treatments for scalp psoriasis include products to soften and loosen the scale (e.g. olive oil, cocois scalp ointment), products to treat the inflammatory lesions, and shampoos. When using agents to soften and loosen scale, gentle, thorough application and adequate contact time (at least one hour) are essential, after which the product is shampooed out. 

UV treatments

Treatments using carefully measured doses of UVB or UVA are available in dedicated phototherapy centres.

Systemic non-biological and biological treatments

Systemic non-biological immunomodulatory treatment and systemic biological therapy may also be an option. The criteria for these are set out in NICE technology appraisals 419 and 475.

Reflective exercise

How would you explain the risks of continual use of potent topical corticosteroids to ensure effective use without fuelling ‘steroid phobia’?